Acute groin injuries in 109 athletes – Clinical and radiological findings

Abstract

Background: Acute groin injuries are common, but there are no high quality studies on injury mechanisms, clinical and radiological findings. The objective of this study was to describe these parameters in a prospective cohort of athletes. Methods: Male athletes (age 18–40) presenting with acute groin pain within 7 days of injury onset were prospectively studied (Aug. 2012–Apr. 2014). All patients underwent a standardized history, clinical examination (pain-provocation tests including palpation, active isometric resistance and passive range of motion), and magnetic resonance imaging and/or ultra sound. A clinical entity approach was used to classify all injuries, and muscle injury distribution through radiology was specified and categorized to similar entities. Results: 109 athletes (age 25.6±4.7 yrs.) were included. Football and futsal players accounted for themajority of theparticipants (74%). The injuries occurred most frequently during kicking (32%), change of direction (20%), in stretch situations (17%), and during running/sprinting (15%). The clinical entities diagnosed were: adductor (66%, n=66), rectus femoris (26%, n=28), iliopsoas (23%, n=25), abdominal (10%, n=11), and sartorius (6%, n=7). Multiple clinical entities were found in 29% (n=32) of the cases, where a combination of adductor and iliopsoas injuries was most frequent (12, 38%). Radiological assessment was negative in 23% of the investigations. An acute adductor injury was present on imaging in 50% of the cases, and in 92% of these there was an injury in the adductor longus muscle. Iliopsoas injuries were found in 14% of cases, and 13% involved the rectus femoris. Findings in multiple entities were present in 8% of the cases, and the most frequent combination was adductor and abdominal (53%). In 47% of the cases, no radiological abnormalities were found in the location suspected clinically, and in 48% of those cases there were positive findings in a different location. Adductor injuries diagnosed clinically rarely had imaging findings in a different location (4%), whereas clinical iliopsoas and rectus femoris injuries had imaging findings in a different location in app. 40% of the cases. Discussion: Adductor-related injuries were the most common acute groin injury, and the kicking action was the most common injury situation. Negative radiological assessment was found in more than1outof 5acutegroin injuries. In1outof 4 cases radiology showed an injury in another location than the clinically examination, which highlights that acute groin injuries, especially iliopsoas and proximal rectus femoris injuries, can be difficult to diagnose.